Download presentation
Presentation is loading. Please wait.
Published byRodney Davis Modified over 9 years ago
1
Chlorhexidine baths and central line associated bloodstream infections (CLABSIs) L. Silvia Munoz-Price, MD Associate Professor of Medicine University of Miami Miller School of Medicine Medical Director - Infection Control Department Jackson Memorial Hospital, Miami, FL www.webbertraining.comOctober 11, 2012 Teleclass Sponsored by Hosted by Paul Webber paul@webbertraining.com
2
Disclosures Speaker for Sage Inc.
3
Outline Broad overview of chlorhexidine Bio-burden of patient’s surfaces (fecal patina) Sources of CLABSIs Chlorhexidine baths for prevention of CLABSIs ◦ Studies using impregnated cloths ◦ Studies using liquid chlorhexidine Conclusions
4
Chlorhexidine gluconate Long acting topical antiseptic In use since 1954 Water soluble Remains active for hours after application Milstone AM, et al. Clin Infec Dis 2008; 46:274-81 Lio PA, Kaye E. Inf Dis Clin North Ame;
5
Chlorhexidine gluconate Binds to negatively charged bacterial cell wall, causing osmotic changes and finally destroying the organism Activity against: ◦ Gram positive bacteria ◦ Gram negative bacteria ◦ Yeast No sporicidal activity Milstone AM, et al. Clin Infec Dis 2008; 46:274-81 Lio PA, Kaye E. Inf Dis Clin North Ame;
6
Chlorhexidine gluconate For skin antisepsis: ◦ Reduction of bacterial skin burden ◦ Reduction of CLABSIs ◦ Reduction of acquisition of certain resistant organisms Pre-operative bathing and scrub Impregnated devices (vascular catheters and dressings) Oropharynx antisepsis Milstone AM, et al. Clin Infec Dis 2008; 46:274-81
7
Main uses of chlorhexidine baths To decrease CLABSIs To decrease acquisition of multidrug resistant organisms To decrease surgical site infections
8
Fecal patina Stool organisms do not remain in the stool but rather contaminate patient’s skin and the environment This is known as fecal patina or fecal veneer RA Weinstein. Crit Care Med 2012; 4: 1333-4 Beezhold DW, et al. Clin Infect Dis 1997; 24:704-6
9
Popovich KJ, et al. Infect Control Hosp Epidemiol 2012; 33: 889-896
12
Why would chlorhexidine decrease CLABSIs? Safdar N, Maki DG. Intensive Care Med 2004; 30:62-67
13
LETS REVIEW THE LITERATURE
14
We will divide the studies based on the preparation used: Chlorhexidine impregnated cloths Chlorhexidine solution
15
STUDIES USING CHLORHEXIDINE IMPREGNATED CLOTHS
17
Bleasdale SC, et al Arch Int Med 2007; 19: 2073-2077
20
Popovich KJ, et al. Infect Control Hosp Epidemiol 2009; 30:959-963
23
Popovich KJ, et al. Intensive Care Med 2010; 36:854-858
25
Munoz-Price LS, et al. Crit Care Med. 2012 May;40(5):1464-9.
26
Phases Phase 1: Baseline Phase 2: Scrub-the hub (chlorhexidine gluconate for 15 sec) Phase 3: 2% chlorhexidine daily body baths AND scrub-the-hub Phase 4: Daily ICU nursing rounds AND 2% CHG AND scrub-the-hub 26 Munoz-Price LS, et al. Crit Care Med. 2012 May;40(5):1464-9.
27
SICUTICU NSICU Munoz-Price LS, et al. Crit Care Med. 2012 May;40(5):1464-9. LOOK ONLY AT THE SOLID LINE (MONTHLY CLABSI RATES)
29
Evans HL, et al. Arch Surg 2010; 145: 240-246
32
Montecalvo MA, et al. Am Journal Med 2012; 125:505-511
34
STUDIES USING CHLORHEXIDINE SOLUTION
36
Gould IM, et al. Int Journal Antimicrobial Agents 2007; 29: 536-543
37
Climo MW, et al. Crit Care Med 2009; 37:1858- 1865
41
Munoz-Price LS, et al. Infect Control Hosp Epidemiol 2009; 30:1031-35
43
O’Horo JC, et al. Inf Control Hosp Epidemiol 2012; 33:257-267
44
IMPLEMENTATION OF CHLORHEXIDINE BATHS IMPLEMENTATION OF CHLORHEXIDINE BATHS Remove all non-compatible products from the units (soaps, lotions, skin barriers, etc) In-service staff giving the baths Personally observe baths in a regular basis Quantify the usage of the product by the units
45
CHALLENGES DURING IMPLEMENTATION OF CHLORHEXIDINE Chlorhexidine doesn’t foam Personnel perceives this lack of foaming as lack of cleaning Mixing with other products (soap and water) might happen at the bedside, especially with liquid preparations
46
Conclusions Chlorhexidine baths constitute a powerful tool to decrease CLABSIs Preparation of the inpatient units should be done before instituting chlorhexidine baths Frequent observations should occur after implementation in order to ensure compliance
47
18 October (South Pacific Teleclass) Meningococcal Disease and the New Zealand Experience – Where to From Here Speaker: Dr. Tony Walls, University of Otago, New Zealand 30 October (British Teleclass) Reduce, Reuse, Recycle – Implications for Infection Prevention and Control Speaker: Dr. Andrew Nichols, Plymouth University, UK 1 November Current Trends and Infection Prevention Issues in Healthcare Laundry Speaker: Prof. Lynne Sehulster, CDC Division of Healthcare Quality Promotion 8 November Surface Disinfection and Microbial Resistance Speaker: Prof. Markus Dettenkofer, University of Freiburg, Germany Teleclass sponsored by Diversey (www.diversey.com) 15 November Human Waste Disposal – Assessing the Risks of Differing Management Solutions
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.